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Hundreds of families come forward in Shropshire maternity scandal

More than 200 new families have contacted an inquiry into mother and baby deaths at a hospital trust in Shropshire.

Investigators were already looking at more than 600 cases where newborns and mothers died or were left injured while in the care of the Shrewsbury and Telford Hospital Trust. One expert says the scandal, spanning decades, may be the tip of the iceberg.

Dr Bill Kirkup says it suggests failure might be more widespread in the NHS.

The surge in new cases follows the leak of an interim report last week.

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Source: BBC News, 27 November 2019

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A third of maternity doctors 'burnt out' and at risk of losing empathy for women in their care

More than a third of maternity doctors are “burnt out,” and at risk of lacking empathy for the women in their care, researchers have warned.

The study of more than 3,000 obstetricians and gynaecologists found high levels of long-term stress and overwork, especially among trainee medics. 

Researchers said the findings – from the largest UK study on the topic – were “very worrying,” with serious implications for patients. 

Overall, 36% of those surveyed met the criteria for “burnout,” which is associated with emotional exhaustion, lack of empathy and connection with others, researchers said. 

Medics who met the criteria for burnout were three times as likely to report anxiety, irritability and anger. They were also four times more likely than colleagues to practice “defensively”- meaning they tried to avoid difficult cases, or else carried out more interventions than necessary, for fear of error. 

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Source: The Telegraph, 26 November 2019

 

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Reflecting on To Err is Human: 20 Years of Patient Safety Work

It’s been 20 years since the Institute of Medicine — known now as the National Academy of Medicine — published the groundbreaking report, To Err is Human. And in that time, the healthcare industry has seen vast changes, bringing patient safety and healthcare quality to the forefront.

The notion that patient safety issues are not only common, but they are preventable, challenge previously held industry beliefs, Craig Clapper, a partner in strategic consulting at Press Ganey, said during a recent interview with PatientEngagementHIT.com. 

In this article he discusses the progress that has been made and what still needs to be done.

Looking into the future, Clapper sees an industry that integrates patient safety as a key element of everything it does. While clinicians focus on boosting patient satisfaction, delivering good clinical outcomes, and fulfilling other obligations, they should feel and see the connection with patient safety.

“We should talk less about safety culture in isolation and more about how to make it about the entire patient experience,” Clapper concluded. “That'll be our biggest single advantage in the next decade. Instead of having a subculture for every outcome, we must have one seamless performance culture that can emphasize the safety, quality, and experience of care.”

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Source: PatientEngagementHIT, 26 November 2019

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CervicalCheck: Review finds hundreds of previously missed abnormal results

Large numbers of previously missed abnormalities have been uncovered in the biggest review of smear tests undertaken since cervical cancer screening began in Ireland.

The review led by the Royal College of Obstetricians and Gynaecologists in the UK has found hundreds of “discordant” results after re-examining the slides of over 1,000 women who had been tested for the disease under CervicalCheck, were given the all-clear and later developed cancer, according to an informed source.

Discordant means the re-examination of the smear test by Royal College reviewers has produced a result that is different from the original finding by CervicalCheck.

The extent of the individual divergences from the initial results is not yet known, but the review has found some cancers could have been prevented, it is understood.

The college is due to submit an aggregate report on its findings to Minister for Health Simon Harris shortly.

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Source: The Irish Times

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New legislation to provide for mandatory open disclosure

Hospitals will face penalties if staff do not notify patients of serious adverse incidents under proposed new legislation.

Due to be brought to Cabinet by the Minister for Health Simon Harris in early December, it will provide for mandatory open disclosure of patient safety issues. It is understood that the new Bill would mean that where a hospital or health service provider was satisfied that a notifiable patient safety incident had occurred, information in its possession on the issue should be disclosed. A doctor or practitioner would be obliged to inform the patient and hospital of the incident.

Under the proposals, failure to comply with this requirement on disclosure would mean the health service provider would be penalised. The nature or extent of the proposed penalties is unknown.

The department is preparing a list of notifiable patient safety incidents for the mandatory open disclosure proposals.

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Source: The Irish Times, 25 November 2019

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Hancock rejects GP vote to remove home visits from contracts

Health Secretary Matt Hancock has ruled out scrapping home visits by GPs, describing the idea as “a complete non-starter”.

Doctors argued that they were no longer able to provide home visits as part of their core work and voted at a conference on Friday to remove them from their NHS contract. Under the proposals GPs would negotiate a separate service for urgent visits to patients. However, the health secretary said he was strongly opposed to the plans and insisted that they would not come to fruition.

“The idea that people shouldn’t be able, when they need it, to have a home visit from a GP is a complete non-starter and it won’t succeed in their negotiations,” he told BBC Radio 4’s Today programme.

He admitted that most home visits were done by nurses but said that on some occasions a GP was needed.

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Source: The Independent, 24 November 2019

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No safety switch: How lax oversight of EHRs puts patients at risk

Back in 2009, healthcare experts, including mainly members of the American Medical Informatics Association, envisioned creating a national databank to track reports of deaths, injuries and near misses linked to issues with the move to have computerised medical records.

The experts at that September 2009 meeting agreed that safety should be a top priority as federal officials poured more than $30 billion into subsidies to wire up medical offices and hospitals nationwide. However, it never happened. Instead, plans for putting patient safety first — and for building a comprehensive injury reporting and reviewing system — have stalled for nearly a decade, because manufacturers of electronic health records (EHRs), health care providers, federal health care policy wonks, academics and Congress have either blocked the effort or fought over how to do it properly, an ongoing investigation by Fortune and Kaiser Health News (KHN) shows.

Meanwhile, patients remain at risk of harm. In March, Fortune and KHN revealed that thousands of injuries, deaths or near misses tied to software glitches, user errors, interoperability problems and other flaws have piled up in various government-sponsored and private repositories. One study uncovered more than 9,000 patient safety reports tied to EHR problems at three pediatric hospitals over a five-year period.

Despite such incidents, experts believe EHRs have made medicine safer by eliminating errors due to illegible handwriting and in some cases speeding up access to vital patient files. But they also acknowledge they have no idea how much safer, or how much the systems could still be improved because no one — a decade after the federal government all but mandated their adoption — is assessing the technology’s overall safety record.

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Source: Kaiser Health News, 21 November 2019

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Older people dying for want of social care at rate of three an hour, claims charity

At least 74,000 older people in England have died, or will die, waiting for care between the 2017 and 2019 general elections. A total of 81 older people are dying every day, equating to about three an hour, research by Age UK has found.

In the 18 months between the last election and the forthcoming one, 1,725,000 unanswered calls for help for care and support will have been made by older people. This, said the charity, was the equivalent of 2,000 futile appeals a day, or 78 an hour.

Age UK’s director, Caroline Abrahams, said: “This huge number of requests for help did not lead to any support actually being given for three main reasons: because the older people died or will die before services were provided, because of a decision that they did not meet the eligibility criteria as interpreted by their local authority, or because their local authority signposted them to some other kind of help than a care service.”

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Source: The Guardian, 22 November 2019

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Shrewsbury maternity scandal: Medical watchdog asks NHS for information about doctors at trust

The General Medical Council (GMC) has asked the NHS to share concerns about any doctors involved in poor care at the Shrewsbury and Telford Hospital Trust.

It comes as West Mercia Police said it was considering a range of criminal charges against the hospital including corporate manslaughter.

Anthony Omo, Director of Fitness to Practice for the GMC, said the reports of poor maternity care at the trust were “shocking” and his thoughts were with the families. He added: “We are in contact with the trust and have asked NHS England and NHS Improvement for details of any concerns about individual doctors." 

“All doctors have a responsibility to take action if they are aware that patient safety may be put at risk.”

Meanwhile, the Royal College of Obstetricians and Gynaecologists has said it will make changes to the way it inspects hospitals after criticism of the way it allowed a report into the Shrewsbury trust in 2017 to be used.

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Source: The Independent, 22 November 2019

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NHS staff shortages put 'cancer survival rates at risk'

Progress on treating cancer has stalled in Scotland because of staff shortages and a lack of funding, according to a parliamentary report.

The Scottish Parliament's Cross-Party Group on Cancer found that 18% of cancer patients in June were not seen within the six-week target. Their report, which will be published later, has been described as "deeply concerning" by Cancer Research UK.

The Scottish government said its £100m strategy would improve survival rates.

Cancer Research UK Chief Executive Michelle Mitchell said the Scottish government must "publish a long-term cancer workforce plan" to enable the NHS to prepare for rising demand in the future. She said: "The findings of this inquiry are deeply concerning".

"Diagnosing cancer early can make all the difference, but there are major shortages in the staff trained to carry out the tests that diagnose cancer. Cancer services in Scotland are already struggling. Without urgent action, this will only worsen as demand increases."

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Source: BBC News, 18 November 2019

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Insurers overrule consultants on best treatment for patients

Patients are being left in pain and having operations delayed or denied because insurers are overruling consultants’ decisions on treatment.

Policy holders with breast cancer, heart conditions, arthritis and knee problems are among those who have been unfairly denied procedures, The Times has found.

Analysis of Financial Ombudsman Service reports shows that complaints about private medical insurers have risen sharply.

Richard Packard, chairman of the Federation of Independent Practitioner Organisations, estimates that hundreds of patients a year are denied recommended treatments. “Consultants have reported that their expert decisions for the benefit of the patient are being overturned,” he said. “This is being done by insurance administrators at the end of a telephone. Some would seem to lack medical knowledge and [make] decisions based on computer algorithms, which can result in delayed treatment and patients suffering pain for longer than necessary.”

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Source: The Times, 18 November 2019

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World Antibiotic Awareness Week: Letter from senior NHS and health system leaders

The World Health Organization's (WHO) World Antibiotic Awareness Week (WAAW) aims to increase awareness of antibiotic resistance as a global problem, and to promote best practices among the general public, health workers and policy-makers to avoid the further emergence and spread of antibiotic resistance.

Since their discovery, antibiotics have served as the cornerstone of modern medicine. However, the persistent overuse and misuse of antibiotics in human and animal health have encouraged the emergence and spread of antibiotic resistance, which occurs when microbes, such as bacteria, become resistant to the drugs used to treat them.

As part of preparations for the 2019 Awareness Week this November, a group of senior leaders from across the health system, including NHS England and Improvement, have co-signed a letter, coordinated by Public Health England, that reminds commissioners and providers alike of their responsibility to contribute to this important agenda. The letter also reminds colleagues that this year’s WAAW campaign is the first of a new five-year UK National Action Plan for antimicrobial resistance, which contains stretching ambitions for reducing inappropriate prescriptions; as well as controlling and preventing infections.

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Bradford Teaching Hospitals Command Centre officially opens

At a launch event last week, Bradford Teaching Hospitals NHS Foundation Trust has officially opened its new Command Centre.

The Command Centre, using technology from GE Healthcare Partners, went live earlier this year and was recently awarded Tech Project of the Year in the innovative Health Tech Awards 2019.

The Trust said it helps staff to optimise patient flow and allow real-time co-ordination of care for each and every patient. Using advanced analytics and machine learning, the new system provides staff with real-time information to help them make speedy and informed decisions on managing patient flow across the Trust’s hospitals.

Sandra Shannon, Chief Operating Officer and Deputy Chief Executive at the Trust “Demand for services is growing at Bradford Teaching Hospitals every year, with up to 400 patients coming through our A&E every day, and we have to get smarter at how we manage the needs of patients with the resources we have.”

“The Command Centre is a major investment in how we, as a very busy acute Trust, can improve our performance, maintain and improve patients’ experience of coming into hospital and support our staff to do their jobs more efficiently, so they can concentrate on delivering excellent patient care.”

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Source: Health Tech Newspaper, 12 November 2019

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A&E waiting times in England at their worst on record

A&E waiting times are at their worst on record as the NHS comes under intense pressure before what doctors and hospital bosses fear will be a very tough winter for the service.

Less than three-quarters (74.5%) of people who sought care at A&E unit in England in October were treated and then discharged, admitted or transferred within four hours – the smallest proportion since the target was introduced in 2004.

That is far below the 95% of patients that ministers and NHS chiefs say should be dealt with by A&E staff within four hours.

“As political parties vie to prove their NHS credentials, today’s figures highlight that the NHS is desperately struggling to stay afloat,” said Dr Rebecca Fisher, a GP and senior policy fellow at the Health Foundation.

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Source: The Guardian, 14 November 2019

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Opinion: I’m stuck in a hospital that’s starved of funds – let’s not forget the NHS when we vote

Having spent 5 months in a hospital bed, Jame Hale, a disabled poet and essayist, urges us as we go into this election not to forget the damage that’s been done to the NHS – and the individual, human casualties that have resulted. 

"High-quality staff are not enough if we put them in environments where they cannot do their best", Jame says to the Guardian newspaper. 

"An NHS in this state is a stain on the country, and an ongoing risk to patient safety. It’s come about because of nine years of persistent underfunding and austerity, which has come on top of PFI hospital-building initiatives that have loaded hospital trusts with unsustainable repayments."

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Source: The Guardian, 7 November 2019

 

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Child's hospital death 'linked to contaminated water'

A whistleblower claimed a cancer patient died as a result of contaminated water at Scotland's largest hospital. The whistleblower raised concerns about the findings of a review into infections in child cancer patients.

Jeane Freeman, the health secretary, says she knew in September a child had died after contracting an infection possibly linked to water at the Queen Elizabeth University Hospital, but did not make it public. She told BBC Scotland she acted on the information but chose to maintain patient confidentiality.

Ms Freeman said she felt for the child's parents. She said: "I deeply regret not only the death of their child. In any circumstance that has to cause a pain that I can't possibly imagine, but I also deeply regret that they feel they haven't been given the information that they have a perfect right to receive and are entitled to. They have my commitment to act to ensure that situation does not happen to parents in the future".

"I don't regret honouring patient confidentiality. But upholding patient confidentiality does not mean I don't act on the information I am given."

Labour MSP Anas Sarwar had raised the issue - which was brought to light by an NHS whistleblower - during First Minister's Questions on Thursday. He  described the situation as a "cover-up".

The MSP said he had seen information which showed that senior managers were repeatedly alerted to the fact a previous review failed to include cases of infection related to the water supply in 2017. He said the parents of the child had never been told the true cause of their child's death.

Greater Glasgow Health Board say a link between the infection and the hospital cannot be proven because regulations at the time did not require water testing.

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Source: BBC News, 14 November 2019

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NIH grant to study unstructured data that can improve patient safety

Reports that medical errors are the third leading cause of death in the US have led the Institute of Medicine and several state legislatures to suggest that data from patient safety event reporting systems could help health care providers better understand safety hazards and, ultimately, improve patient care.

"Tens of thousands of these safety report databases provide a free text field that does not constrain the reporter to fixed, predefined categories," said Srijan Sengupta, Assistant Professor of Statistics in the College of Science and a faculty member at the Discovery Analytics Center.

Sengupta has received an $815,218 Research Project Grant (R01) from the National Institutes of Health (NIH) to develop novel statistical methods to analyze such unstructured data in safety reports.

"Detailed information that spans multiple categories can be more valuable than identifying an event by just checking off a category," he said.

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Source: EurekAlert, 13 November 2019

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Little evidence that locum GPs pose greater risk to patient safety, study finds

Existing claims that locum GPs present a greater risk of harming patients are unfounded, according to new research published in the Journal of the Royal Society of Medicine. It found that there is little evidence that locum doctors, including GPs, have a 'detrimental' impact on patient care delivery.

Researchers from the University of Manchester looked at 42 international papers, including 24 from the UK, on the impact of locum doctors working in various healthcare settings to determine whether this group is more likely to harm patients than permanent doctors. 

Previous reports highlight longstanding and growing concerns about the quality, safety and cost of locum doctors among a range of stakeholders such as policymakers, employers, regulators and professional bodies. These include locum GPs being less aware of local policies and less familiar with the patient's healthcare history and lacking commitment. 

However, the researchers found there is 'very limited evidence' to support claims that these healthcare professionals deliver lower quality of care than their permanent counterparts. 

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Source: Pulse, 12 November 2019

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Hospital deploys new £700,000 computer system to improve patient safety in intensive care unit

A new £700,000 computer system has been deployed in an intensive care unit at Aberdeen Royal Infirmary. The new Philips system will replace bedside charts, freeing up clinical time and improving patient safety at the NHS Grampian hospital.

ICU clinical director Dr Iain MacLeod said: “At the heart of this change is patient safety. The system records physical measurements like blood pressure and heart rate as well as blood results and parameters from the various machines used in ICU, such as dialysis machines and ventilators."

“It will also save on staff time. Currently medical staff members waste lots of time transcribing blood results from a computer onto sheets of paper. The new system allows this to happen automatically. That’s great from a timesaving point of view but more importantly there will be a reduction of errors that can happen when writing something down.”

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Source: FutureScot, 11 November 2019

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Thousands of bowel cancer cases missed due to ‘unacceptable’ testing failures

Thousands of bowel cancer cases are being missed due to “unacceptable” testing failures, research in the BMJ shows. 

The UK research found that some providers carrying out colonoscopies were three times as likely as others not to spot signs of disease. At the worst units, almost one in ten cases which turned out to be bowel cancer were not picked up during the tests, the study led by the University of Leeds found. 

Researchers said that almost 4,000 more cases could have been prevented or treated sooner had there been better screening over a nine year period tracked. 

Researcher Roland Valori, Consultant Gastroenterologist from Gloucestershire Hospitals NHS Foundation Trust, said: “We are seeing unacceptable variation in post colonoscopy bowel cancers between providers in the English NHS and this variation in quality needs to be addressed urgently.” 

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Source: The Telegraph, 2019

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New inpatients banned at mental health unit rated unsafe

A privately run mental health unit has been banned from admitting new patients after inspectors found numerous safety failings, one of which led to a resident dying by hanging.

The Care Quality Commission (CQC) has stopped the Cygnet Acer Clinic, in Chesterfield, Derbyshire, from accepting new inpatients. It declared that the facility was “not safe” for people to use.

Inspectors found that clinic patients had opportunities to hang themselves, and the unit had soaring levels of patient self harm, and a huge shortage of trained staff.

The CQC’s report is one of the most damning it has issued about poor and unsafe care affecting vulnerable and potentially suicidal patients in a mental health facility.

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Source: The Guardian, 13 November 2019

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Patient identity management: a patient safety concern

Fragmented patient data can lead to redundant and unnecessary care, potentially harming individuals. Thought leaders are calling for standardised methods to identify patients and minimise potential harm.

At a recent US Food and Drug Administration conference for improved data standards, Shaun Grannis, Regenstrief Institute Vice President of Data and Analytics, advocated for standards that promote better patient matching.

“Any time you lack complete information to make the best decision possible, there's an opportunity for error,” Grannis said. “Patient matching is a safety issue. Patient identification is paramount to making sure that patients receive appropriate, safe care.”

Grannis noted that patient data is currently fragmented across healthcare systems. Patients often do not receive care at just one facility or in one health system.

“They’re going to be identified differently across organizations. You might go to your primary care doctor or they refer you to a specialist who’s outside of your system, so your data is fragmented,” he continued.

Disjointed data can make it difficult for providers to make decisions about patient care. Without a complete picture of the patient’s medical history, it is more challenging for clinicians to make care decisions.

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Source: EHR Intelligence, 12 November 2019

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Dozens of doctors issue ‘grave’ safety warning over plans to reform NHS cancer services

Dozens of doctors from across Greater Manchester have warned health bosses plans to reform cancer services in the city will put patients at risk and destabilise smaller hospitals.

In a letter, seen by The Independent, to the head of the devolved NHS and social care system for the city, almost 40 urological consultants called on the NHS to abandon its plans.

NHS leaders are aiming to centralise hundreds of bladder and kidney cancer operations a year at the University Hospital of South Manchester but the doctors warn this will make their roles in smaller district general hospitals harder to recruit to and leave patients who need input from urologists at a disadvantage. Ultimately they fear the reorganisation could put services at smaller hospitals such as emergency care, gynaecology, trauma and obstetrics at risk because of the role urologist play in their delivery.

The letter added: “The inevitable consequences of centralisation of complex urological cancer services on a single site will result in an inability to provide a safe sustainable comprehensive service to large areas of the city, particularly those areas which are already under resourced with regard to access to care and which have the highest levels of social deprivation."

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Source: The Independent, 12 November 2019

 

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Three patients died after radiology failings at teaching hospital

Radiology failings at a teaching hospital led to eight patients coming to severe harm, with three dying, a hospital trust has admitted. 

A report into issues at St George’s University Hospitals Foundation Trust identified multiple problems, including staff missing cancers, improperly reported results and diagnoses being sent to unmonitored inboxes.

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Source: HSJ, 11 November 2019

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